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van den Dobbelsteen M, Hackett SL, van Asselen B, Oolbekkink S, Raaymakers BW, de Boer JC. Treatment planning evaluation and experimental validation of the magnetic resonance-based intrafraction drift correction. Phys Imaging Radiat Oncol 2024; 30:100580. [PMID: 38707627 PMCID: PMC11068926 DOI: 10.1016/j.phro.2024.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background and purpose MRI-guided online adaptive treatments can account for interfractional variations, however intrafraction motion reduces treatment accuracy. Intrafraction plan adaptation methods, such as the Intrafraction Drift Correction (IDC) or sub-fractionation, are needed. IDC uses real-time automatic monitoring of the tumor position to initiate plan adaptations by repositioning segments. IDC is a fast adaptation method that occurs only when necessary and this method could enable margin reduction. This research provides a treatment planning evaluation and experimental validation of the IDC. Materials and methods An in silico treatment planning evaluation was performed for 13 prostate patients mid-treatment without and with intrafraction plan adaptation (IDC and sub-fractionation). The adaptation methods were evaluated using dose volume histogram (DVH) metrics. To experimentally verify IDC a treatment was mimicked whereby a motion phantom containing an EBT3 film moved mid-treatment, followed by repositioning of segments. In addition, the delivered treatment was irradiated on a diode array phantom for plan quality assurance purposes. Results The planning study showed benefits for using intrafraction adaptation methods relative to no adaptation, where the IDC and sub-fractionation showed consistently improved target coverage with median target coverages of 100.0%. The experimental results verified the IDC with high minimum gamma passing rates of 99.1% and small mean dose deviations of maximum 0.3%. Conclusion The straightforward and fast IDC technique showed DVH metrics consistent with the sub-fractionation method using segment weight re-optimization for prostate patients. The dosimetric and geometric accuracy was shown for a full IDC workflow using film and diode array dosimetry.
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Affiliation(s)
- Madelon van den Dobbelsteen
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sara L. Hackett
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bram van Asselen
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Stijn Oolbekkink
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas W. Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Johannes C.J. de Boer
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Kaushik SS, Bylund M, Cozzini C, Shanbhag D, Petit SF, Wyatt JJ, Menzel MI, Pirkl C, Mehta B, Chauhan V, Chandrasekharan K, Jonsson J, Nyholm T, Wiesinger F, Menze B. Region of interest focused MRI to synthetic CT translation using regression and segmentation multi-task network. Phys Med Biol 2023; 68:195003. [PMID: 37567235 DOI: 10.1088/1361-6560/acefa3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/10/2023] [Indexed: 08/13/2023]
Abstract
Objective. In MR-only clinical workflow, replacing CT with MR image is of advantage for workflow efficiency and reduces radiation to the patient. An important step required to eliminate CT scan from the workflow is to generate the information provided by CT via an MR image. In this work, we aim to demonstrate a method to generate accurate synthetic CT (sCT) from an MR image to suit the radiation therapy (RT) treatment planning workflow. We show the feasibility of the method and make way for a broader clinical evaluation.Approach. We present a machine learning method for sCT generation from zero-echo-time (ZTE) MRI aimed at structural and quantitative accuracies of the image, with a particular focus on the accurate bone density value prediction. The misestimation of bone density in the radiation path could lead to unintended dose delivery to the target volume and results in suboptimal treatment outcome. We propose a loss function that favors a spatially sparse bone region in the image. We harness the ability of the multi-task network to produce correlated outputs as a framework to enable localization of region of interest (RoI) via segmentation, emphasize regression of values within RoI and still retain the overall accuracy via global regression. The network is optimized by a composite loss function that combines a dedicated loss from each task.Main results. We have included 54 brain patient images in this study and tested the sCT images against reference CT on a subset of 20 cases. A pilot dose evaluation was performed on 9 of the 20 test cases to demonstrate the viability of the generated sCT in RT planning. The average quantitative metrics produced by the proposed method over the test set were-(a) mean absolute error (MAE) of 70 ± 8.6 HU; (b) peak signal-to-noise ratio (PSNR) of 29.4 ± 2.8 dB; structural similarity metric (SSIM) of 0.95 ± 0.02; and (d) Dice coefficient of the body region of 0.984 ± 0.Significance. We demonstrate that the proposed method generates sCT images that resemble visual characteristics of a real CT image and has a quantitative accuracy that suits RT dose planning application. We compare the dose calculation from the proposed sCT and the real CT in a radiation therapy treatment planning setup and show that sCT based planning falls within 0.5% target dose error. The method presented here with an initial dose evaluation makes an encouraging precursor to a broader clinical evaluation of sCT based RT planning on different anatomical regions.
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Affiliation(s)
- Sandeep S Kaushik
- GE Healthcare, Munich, Germany
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
| | - Mikael Bylund
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | | | | | - Steven F Petit
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Jonathan J Wyatt
- Translational and Clinical Research Institute, Newcastle University and Northern Centre for Cancer Care, Newcastle upon Tyne Hospitals NHS Foundation Trust, United Kingdom
| | - Marion I Menzel
- GE Healthcare, Munich, Germany
- Dept. of Physics, Technical University of Munich, Munich, Germany
| | | | | | - Vikas Chauhan
- Sree Chitra Tirunal Institute of Medical Sciences and Technology (SCTIMST), Trivandrum, India
| | | | - Joakim Jonsson
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, UmeåUniversity, Umea, Sweden
| | | | - Bjoern Menze
- Department of Quantitative Biomedicine, University of Zurich, Zurich, Switzerland
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Bosma LS, Zachiu C, Denis de Senneville B, Raaymakers BW, Ries M. Technical note: Intensity-based quality assurance criteria for deformable image registration in image-guided radiotherapy. Med Phys 2023; 50:5715-5722. [PMID: 36932727 DOI: 10.1002/mp.16367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 02/01/2023] [Accepted: 03/01/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Deformable image registration is increasingly used in radiotherapy to adapt the treatment plan and accumulate the delivered dose. Consequently, clinical workflows using deformable image registration require quick and reliable quality assurance to accept registrations. Additionally, for online adaptive radiotherapy, quality assurance without the need for an operator to delineate contours while the patient is on the treatment table is needed. Established quality assurance criteria such as the Dice similarity coefficient or Hausdorff distance lack these qualities and also display a limited sensitivity to registration errors beyond soft tissue boundaries. PURPOSE The purpose of this study is to investigate the existing intensity-based quality assurance criteria structural similarity and normalized mutual information for their ability to quickly and reliably identify registration errors for (online) adaptive radiotherapy and compare them to contour-based quality assurance criteria. METHODS All criteria were tested using synthetic and simulated biomechanical deformations of 3D MR images as well as manually annotated 4D CT data. The quality assurance criteria were scored for classification performance, for their ability to predict the registration error, and for their spatial information. RESULTS We found that besides being fast and operator-independent, the intensity-based criteria have the highest area under the receiver operating characteristic curve and provide the best input for models to predict the registration error on all data sets. Structural similarity furthermore provides spatial information with a higher gamma pass rate of the predicted registration error than commonly used spatial quality assurance criteria. CONCLUSIONS Intensity-based quality assurance criteria can provide the required confidence in decisions about using mono-modal registrations in clinical workflows. They thereby enable automated quality assurance for deformable image registration in adaptive radiotherapy treatments.
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Affiliation(s)
- Lando S Bosma
- Department of Radiotherapy, UMC Utrecht, Utrecht, The Netherlands
| | - Cornel Zachiu
- Department of Radiotherapy, UMC Utrecht, Utrecht, The Netherlands
| | - Baudouin Denis de Senneville
- Department of Radiotherapy, UMC Utrecht, Utrecht, The Netherlands
- Institut de Mathématiques de Bordeaux (IMB), University of Bordeaux, Talence, France
| | - Bas W Raaymakers
- Department of Radiotherapy, UMC Utrecht, Utrecht, The Netherlands
| | - Mario Ries
- Imaging Division, UMC Utrecht, Utrecht, The Netherlands
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Bosma LS, Ries M, Denis de Senneville B, Raaymakers BW, Zachiu C. Integration of operator-validated contours in deformable image registration for dose accumulation in radiotherapy. Phys Imaging Radiat Oncol 2023; 27:100483. [PMID: 37664798 PMCID: PMC10472292 DOI: 10.1016/j.phro.2023.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023] Open
Abstract
Background and Purpose Deformable image registration (DIR) is a core element of adaptive radiotherapy workflows, integrating daily contour propagation and/or dose accumulation in their design. Propagated contours are usually manually validated and may be edited, thereby locally invalidating the registration result. This means the registration cannot be used for dose accumulation. In this study we proposed and evaluated a novel multi-modal DIR algorithm that incorporated contour information to guide the registration. This integrates operator-validated contours with the estimated deformation vector field and warped dose. Materials and Methods The proposed algorithm consisted of both a normalized gradient field-based data-fidelity term on the images and an optical flow data-fidelity term on the contours. The Helmholtz-Hodge decomposition was incorporated to ensure anatomically plausible deformations. The algorithm was validated for same- and cross-contrast Magnetic Resonance (MR) image registrations, Computed Tomography (CT) registrations, and CT-to-MR registrations for different anatomies, all based on challenging clinical situations. The contour-correspondence, anatomical fidelity, registration error, and dose warping error were evaluated. Results The proposed contour-guided algorithm considerably and significantly increased contour overlap, decreasing the mean distance to agreement by a factor of 1.3 to 13.7, compared to the best algorithm without contour-guidance. Importantly, the registration error and dose warping error decreased significantly, by a factor of 1.2 to 2.0. Conclusions Our contour-guided algorithm ensured that the deformation vector field and warped quantitative information were consistent with the operator-validated contours. This provides a feasible semi-automatic strategy for spatially correct warping of quantitative information even in difficult and artefacted cases.
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Affiliation(s)
- Lando S Bosma
- Department of Radiotherapy, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Mario Ries
- Imaging Division, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Baudouin Denis de Senneville
- Department of Radiotherapy, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
- Institut de Mathématiques de Bordeaux (IMB), UMR 5251 CNRS/University of Bordeaux, F-33400 Talence, France
| | - Bas W Raaymakers
- Department of Radiotherapy, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Cornel Zachiu
- Department of Radiotherapy, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Zhang Y, Balter J, Dow J, Cao Y, Lawrence TS, Kashani R. Development of an abdominal dose accumulation tool and assessments of accumulated dose in gastrointestinal organs. Phys Med Biol 2023; 68:10.1088/1361-6560/acbc61. [PMID: 36791470 PMCID: PMC10131348 DOI: 10.1088/1361-6560/acbc61] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 02/15/2023] [Indexed: 02/17/2023]
Abstract
Objective.Online adaptive radiotherapy has demonstrated improved dose conformality in response to inter-fraction geometric variations in the abdomen. The dosimetric impact of intra-fractional variations in anatomic configuration resulting from breathing, gastric contraction and slow configuration motion, however, have been largely ignored, leading to differences between delivered and planned. To investigate the impact of intra-fractional abdominal motions on delivered dose, anatomical deformations due to these three motion modes were extracted from dynamic MRI data using a previously developed hierarchical motion modeling methodology.Approach. Motion magnitudes were extracted from deformation fields between a reference state and all other motion states of the patient. Delivered dose estimates to various gastrointestinal organs (stomach, duodenum, small bowel and colon) were calculated on each motion state of the patient and accumulated to estimate the delivered dose to each organ for the entire treatment fraction.Main results. Across a sample of 10 patients, maximal motions of 33.6, 33.4, 47.6 and 49.2 mm were observed over 20 min for the stomach, duodenum, small bowel and colon respectively. Dose accumulation results showed that motions could lead to average increases of 2.0, 2.1, 1.1, 0.7 Gy to the maximum dose to 0.5cc (D0.5cc) and 3.0, 2.5, 1.3, 0.9 Gy to the maximum dose to 0.1cc (D0.1cc) for these organs at risk. From the 40 dose accumulations performed (10 for each organ at risk), 27 showed increases of modeled delivered dose compared to planned doses, 4 of which exceeded planned dose constraints.Significance. The use of intra-fraction motion measurements to accumulate delivered doses is feasible, and supports retrospective estimation of dose delivery to improve estimates of delivered doses, and further guide strategies for both plan adaptation as well as advances in intra-fraction motion management.
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Affiliation(s)
- Yuhang Zhang
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
| | - James Balter
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
| | - Janell Dow
- Department of Radiation Oncology, University of Michigan, United States of America
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, United States of America
- Department of Biomedical Engineering, University of Michigan, United States of America
- Department of Radiology, University of Michigan, United States of America
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, United States of America
| | - Rojano Kashani
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, United States of America
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Feasibility of delivered dose reconstruction for MR-guided SBRT of pancreatic tumors with fast, real-time 3D cine MRI. Radiother Oncol 2023; 182:109506. [PMID: 36736589 DOI: 10.1016/j.radonc.2023.109506] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE In MR-guided SBRT of pancreatic cancer, intrafraction motion is typically monitored with (interleaved) 2D cine MRI. However, tumor surroundings are often not fully captured in these images, and motion might be distorted by through-plane movement. In this study, the feasibility of highly accelerated 3D cine MRI to reconstruct the delivered dose during MR-guided SBRT was assessed. MATERIALS AND METHODS A 3D cine MRI sequence was developed for fast, time-resolved 4D imaging, featuring a low spatial resolution that allows for rapid volumetric imaging at 430 ms. The 3D cines were acquired during the entire beam-on time of 23 fractions of online adaptive MR-guided SBRT for pancreatic tumors on a 1.5 T MR-Linac. A 3D deformation vector field (DVF) was extracted for every cine dynamic using deformable image registration. Next, these DVFs were used to warp the partial dose delivered in the time interval between consecutive cine acquisitions. The warped dose plans were summed to obtain a total delivered dose. The delivered dose was also calculated under various motion correction strategies. Key DVH parameters of the GTV, duodenum, small bowel and stomach were extracted from the delivered dose and compared to the planned dose. The uncertainty of the calculated DVFs was determined with the inverse consistency error (ICE) in the high-dose regions. RESULTS The mean (SD) relative (ratio delivered/planned) D99% of the GTV was 0.94 (0.06), and the mean (SD) relative D0.5cc of the duodenum, small bowel, and stomach were respectively 0.98 (0.04), 1.00 (0.07), and 0.98 (0.06). In the fractions with the lowest delivered tumor coverage, it was found that significant lateral drifts had occurred. The DVFs used for dose warping had a low uncertainty with a mean (SD) ICE of 0.65 (0.07) mm. CONCLUSION We employed a fast, real-time 3D cine MRI sequence for dose reconstruction in the upper abdomen, and demonstrated that accurate DVFs, acquired directly from these images, can be used for dose warping. The reconstructed delivered dose showed only a modest degradation of tumor coverage, mostly attainable to baseline drifts. This emphasizes the need for motion monitoring and development of intrafraction treatment adaptation solutions, such as baseline drift corrections.
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Wahlstedt I, George Smith A, Andersen CE, Behrens CP, Nørring Bekke S, Boye K, van Overeem Felter M, Josipovic M, Petersen J, Risumlund SL, Tascón-Vidarte JD, van Timmeren JE, Vogelius IR. Interfractional dose accumulation for MR-guided liver SBRT: Variation among algorithms is highly patient- and fraction-dependent. Radiother Oncol 2022; 182:109448. [PMID: 36566988 DOI: 10.1016/j.radonc.2022.109448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Daily plan adaptations could take the dose delivered in previous fractions into account. Due to high dose delivered per fraction, low number of fractions, steep dose gradients, and large interfractional organ deformations, this might be particularly important for liver SBRT. This study investigates inter-algorithm variation of interfractional dose accumulation for MR-guided liver SBRT. MATERIALS AND METHODS We assessed 27 consecutive MR-guided liver SBRT treatments of 67.5 Gy in three (n = 15) or 50 Gy in five fractions (n = 12), both prescribed to the GTV. We calculated fraction doses on daily patient anatomy, warped these doses to the simulation MRI using seven different algorithms, and accumulated the warped doses. Thus, we obtained differences in planned doses and warped or accumulated doses for each algorithm. This enabled us to calculate the inter-algorithm variations in warped doses per fraction and in accumulated doses per treatment course. RESULTS The four intensity-based algorithms were more consistent with planned PTV dose than affine or contour-based algorithms. The mean (range) variation of the dose difference for PTV D95% due to dose warping by these intensity-based algorithms was 10.4 percentage points (0.3 to 43.7) between fractions and 8.6 (0.3 to 24.9) between accumulated treatment doses. As seen by these ranges, the variation was very dependent on the patient and the fraction being analyzed. Nevertheless, no correlations between patient or plan characteristics on the one hand and inter-algorithm dose warping variation on the other hand was found. CONCLUSION Inter-algorithm dose accumulation variation is highly patient- and fraction-dependent for MR-guided liver SBRT. We advise against trusting a single algorithm for dose accumulation in liver SBRT.
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Affiliation(s)
- Isak Wahlstedt
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark; Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark.
| | - Abraham George Smith
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | - Claus Erik Andersen
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark
| | - Claus Preibisch Behrens
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark; Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Susanne Nørring Bekke
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Kristian Boye
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette van Overeem Felter
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jens Petersen
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | - Signe Lenora Risumlund
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - José David Tascón-Vidarte
- Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | | | - Ivan Richter Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Willigenburg T, van der Velden JM, Zachiu C, Teunissen FR, Lagendijk JJW, Raaymakers BW, de Boer JCJ, van der Voort van Zyp JRN. Accumulated bladder wall dose is correlated with patient-reported acute urinary toxicity in prostate cancer patients treated with stereotactic, daily adaptive MR-guided radiotherapy. Radiother Oncol 2022; 171:182-188. [PMID: 35489444 DOI: 10.1016/j.radonc.2022.04.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance (MR)-guided linear accelerators (MR-Linac) enable accurate estimation of delivered doses through dose accumulation using daily MR images and treatment plans. We aimed to assess the association between the accumulated bladder (wall) dose and patient-reported acute urinary toxicity in prostate cancer (PCa) patients treated with stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS One-hundred-and-thirty PCa patients treated on a 1.5T MR-Linac were included. Patients filled out International Prostate Symptom Scores (IPSS) questionnaires at baseline, 1 month, and 3 months post-treatment. Deformable image registration-based dose accumulation was performed to reconstruct the delivered dose. Dose parameters for both bladder and bladder wall were correlated with a clinically relevant increase in IPSS (≥10 points) and/or start of alpha-blockers within 3 months using logistic regression. RESULTS Thirty-nine patients (30%) experienced a clinically relevant IPSS increase and/or started with alpha-blockers. Bladder D5cm3, V10-35Gy (in %), and Dmean and Bladder wall V10-35Gy (cm3 and %) and Dmean were correlated with the outcome (odds ratios 1.04-1.33, p-values 0.001-0.044). Corrected for baseline characteristics, bladder V10-35Gy (in %) and Dmean and bladder wall V10-35Gy (cm3 and %) and Dmean were still correlated with the outcome (odds ratios 1.04-1.30, p-values 0.001-0.028). Bladder wall parameters generally showed larger AUC values. CONCLUSION This is the first study to assess the correlation between accumulated bladder wall dose and patient-reported urinary toxicity in PCa patients treated with MR-guided SBRT. The dose to the bladder wall is a promising parameter for prediction of patient-reported urinary toxicity and therefore warrants prospective validation and consideration in treatment planning.
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Affiliation(s)
- Thomas Willigenburg
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands.
| | - Joanne M van der Velden
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
| | - Cornel Zachiu
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
| | - Frederik R Teunissen
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
| | - Jan J W Lagendijk
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
| | - Bas W Raaymakers
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
| | - Johannes C J de Boer
- University Medical Center Utrecht, Department of Radiation Oncology, 3508 GA, Utrecht, The Netherlands
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